Ministry of Health 2015/16 Recurrent and Development budget proposals

SHARE   |   Sunday, 01 March 2015   |   By Dorcas Makgatho

1. I would like to share an overview of the services we provide, major activities undertaken, a highlight on progress made by my Ministry and challenges faced during the 2014/2015 financial year.

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Human Resource
2. Chairperson, the backbone of health care delivery is its human resource. It is for this reason that my Ministry continues to invest heavily in its development. However, there is still some shortage of health care workers in some critical areas within my Ministry. The situation is compounded by the system’s inability to attract and retain skilled health professionals. Various interventions have been developed and implemented with varying degrees of success.
3. Chairperson, let me highlight few of interventions being implemented to address some of the challenges: Construction and maintenance of staff housing especially in remote areas, Development and implementation of Health Managers to enhance both corporate and clinical governance, Utilisation of Health Care Assistants, specifically to relief professionals from non-clinical duties, as well as strengthen community health service, Expanding and increasing intake in Institute of Health Sciences and opening of a Medical School in the Country, In determining the required skills mix and numbers of health professionals, the Ministry is currently conducting a workload assessment which will assist with appropriate numbers of health workers needed in facilities,  That notwithstanding, Human Resource for Health (HRH) working conditions need to be improved in order to reach the desired level of performance and health outcomes. This however requires joint effort. There are few proposals that have been submitted for Government consideration including remuneration of nurses with specialities, Attraction and Retention Strategy for health workers.
Health Policies and Acts
4. Chairperson, my Ministry is in the fourth year of implementation of the revised National Health Policy of 2011. Following the finalisation of the Integrated Health Service Plan (IHSP) in 2010, the Ministry undertook O&M review which still undergoing approval process at DPSM.   The main aim of restructuring is to harmonise and align functions of both the Ministry and the District Health Management Teams to improve efficiency and effectiveness in service delivery.  When implemented, the new structure would facilitate effective decentralisation to the districts for better management of health services.
5. Costing of health services as per the essential health package is continuing in phases. The first phase which constituted eight health interventions being HIV/AIDS, TB, Non-communicable diseases, Child Health, Sexual and Reproductive Health, Immunisation, Malaria and Mental Health is at final stage.  The second phase has commenced work on the remaining health interventions that were not covered in the first phase being Water, Sanitation and Hygiene (WASH), Nutrition and Accident and Emergency. Once completed, the Ministry will be in position to ascertain actual cost of providing health services, both direct and indirect.
6. My Ministry with support from WHO and PEPFAR has started the third round of the National Health Accounts.  The results from this study will help the Ministry in its budgeting process as well as assessing whether or not the available resources are allocated appropriately to target high impact interventions.
7. As a way of monitoring performance of the health system, my Ministry has just completed the development of a Data Management Policy, as well as a Monitoring and Evaluation Framework. The two documents are however still to be disseminated to all relevant stakeholders for optimal usage.
Mental Health and Rehabilitation
8. Chairperson, the mental health program has, through integration of community based mental health, strengthened the referral and discharge processes of mental health patients. This was made possible through the formation of multidisciplinary teams which are responsible for comprehensive case management in the Districts. Mental health has been integrated into primary health care in seven districts and the plan is to have it rolled out to all districts. Furthermore, my Ministry in partnership with different partners will review the Mental Disorders Act in the next financial year.
11.  My Ministry has in 2014/15 conducted a situational analysis of rehabilitation program which was intended to guide the development of a Rehabilitation Strategic Plan in 2015/2016. Also, the Disability Card is being reviewed in consultation with relevant stakeholders to improve its access and utilisation by different sectors. 
Health Promotion and Education
12. Chairperson, prevention of ill health starts at an individual level. Initiatives targeting individuals such as building capacity to make informed choices as well as the willingness to adopt healthy lifestyle should be strengthened. My Ministry will continue to intensify Health Promotion and Education through different strategies including advocacy and social mobilisation, print and electronic media campaigns, and road shows in order to empower service providers and the community on prevention and/or management of both communicable and non-communicable diseases throughout their lives.
Environmental and Occupational Health
13. Chairperson, my Ministry is concerned with the burden of tobacco smoking in this country. Smoking has severe health effects in an individual and those that live around them through passive smoking. It is for this reason that my Ministry is now drafting a Tobacco Control Bill which is progress and is due to be completed before the end of the 2015/2016 financial year. Once completed, it will be taken to Cabinet and Parliament.
14. In addition, my Ministry has introduced a 30% Tobacco Levy with the purpose of   promoting projects and activities designed to combat the use of tobacco products and harmful effects thereof. Collections started in July 2014 and as at January 2015, around Eight Million Pula (P8,000,000) was collected.
Nutrition and Food Control
15. Chairperson, my Ministry continues to build integrated programs towards improvement of child nutrition and strengthening food safety systems. In this regard, I am grateful to UNICEF and the Delegation of the European Union who have constantly provided us with both financial and technical assistance in the areas of Community Based Management of Acute Malnutrition, Baby-Mother-Friendly-Hospital-Initiatives and Strengthening of Food Safety Systems. These programs are aimed at finding solutions to addressing malnutrition especially in settlements and rural areas, as well as building capacity in our national food control systems.
16. Street-vended food is a source of ready-made food for consumers. However, it can pose as a health hazard if the necessary foods safety processes are not followed. To address this, in the coming financial year, my Ministry with the participation of other stakeholders will develop a food safety policy guideline for street-vended foods. The intention would be to safeguard public health as well as address food poisoning related to mishandling of food.
17. Chairperson, the development of comprehensive food legislation through the assistance of the European Union is on-going, and continues to build institutional technical capacity within the Ministry. The technical skills attained has assisted my Ministry to set in motion the process to repeal, re-enact, consolidate and amend the current Food Control Act of 1993 to harmonise it with the existing climate of universal food safety for all and economic food industry liberalisation. This process will result in the establishment of a National Food Safety Authority that has the overall coordination of food control, management and safety issues.
Child Health
18. Chairperson, this country continues to experience high rates of cancer. These are often related to lifestyle behaviours such as smoking and alcohol use. In the case of women, they continue to suffer with cervical cancer at a relatively young age. Cervical cancer is caused by virus called Human Papilloma Virus (HPV). It is now known that by preventing this viral infection we can prevent cervical cancer. It is for this reason that my Ministry in conjunction with the Ministry of Education Skills and Development has carried out HPV pilot vaccination of school going girls (9-13 years) in Kweneng East, Kweneng West and Selebi Phikwe districts. To continue with the efforts to prevent cervical cancer and other HPV related diseases, the HPV vaccination will be launched and rolled out nationally in February, 2015 targeting school going and out of school girls aged 9 years to 13 years.
Prevention of Blindness
19. Chairperson, my Ministry is committed to dealing with preventable blindness. With the assistance of partners, my Ministry has been able to train 400 teachers and 140 Health Education Assistants for them to be able to identify and refer children with eye problems to health facilities for further diagnosis and management to avert preventable blindness. The Ministry has also managed to perform over One Thousand Four Hundred (1,400) cataract extractions on people whose sight was already affected.
Ebola Virus Disease
20. Since the outbreak of Ebola Virus Disease in West Africa in early 2014, Botswana has put in place measures to prevent the introduction of cases into the country as well as response strategies in the event that we may have cases. A National Multi-Sectoral Public Health Emergency Preparedness Response and Technical Working Committees have been established at National level to coordinate the national response whilst at the local level Rapid Response Teams are operational. They all meet regularly.
Disease Control
21. Chairperson, the number of TB cases diagnosed and notified as reported by the World Health Organisation has relatively decreased over the years. The estimated TB case detection rate increased from 75% in 2012 to 82% in 2013, a major improvement compared to the global case detection of 64%.This improvement has been due to engagement of the community and private sector in TB care. Despite such notable gains, may I underscore that our burden of TB remains acute as the reported treatment success rate of 76% is way below the global treatment success rate of over 85%.
22. Through support of development partners, my Ministry has rolled 34 rapid and efficient technology for the diagnosis of TB, including drug resistant forms to ensure prompt access to treatment.
23. My Ministry continues with efforts to eliminate malaria since the campaign was launched in 2010. The incidence of reported malaria cases has reduced from 6.69 cases per 1,000 population in 2010 to 0.23 cases per 1,000 population during 2013. Emphasis is now on strengthening surveillance and introduction of radical treatment of malaria cases in preparation for elimination of malaria.
Alcohol and Other Substances Abuse
24. Chairperson, from the campaigns and stakeholder meetings that have been conducted, my Ministry recognises the need to increase rehabilitation services on alcohol and other substances. This includes outpatient and inpatient services. The study conducted on alcohol density that my predecessor mentioned in the previous speech culminated in the production of draft Regulations for Alcohol Marketing. Consultations on these draft Regulations are ongoing.
25. There is an on-going consultancy on the Alcohol and Substance Abuse Framework to inform the setting up of a treatment center for victims of alcohol and substance abuse. The national Alcohol and Substance Abuse Framework will provide guidance on the effective delivery of substance abuse services in the country.
26. My Ministry continues to inform members of the public on the dangers of alcohol and its harm to our society. Communication is being done through radio jingles, newspapers and television. Also, alcohol volunteers continue to conduct campaigns on reduction of alcohol related harm in their respective districts.
27. The alcohol levy has, up to December 2014, collected One billion, Five Hundred and Ninety Two Million, Four Hundred and Fourteen Thousand, One Hundred and Eighty Eight Pula (P1, 592, 414, 188) from the Alcohol Levy Fund.
Non Communicable Diseases
28. Chairperson, there is still a growing concern of Non Communicable diseases in Botswana, which is a reflection of what is happening globally. The main diseases of concern are cardiovascular, cancers, diabetes and chronic respiratory diseases and their major drivers are lifestyle behaviours of tobacco use, excessive alcohol consumption, physical inactivity and unhealthy diets.
29.  As a way of mitigating this burden, the country has conducted the National Non Communicable Disease risk factor survey also known as the STEPS wise survey at the end of 2014. The purpose of the survey was to facilitate the mapping and quantification of the burden of risk factors leading to non-communicable diseases. The results of this survey will be used to inform both policy and response strategies to curb the burden.  My Ministry continues to implement the Non-Communicable Disease strategy of 2011-2016. Major campaigns have been undertaken to educate communities on risk factors under the theme: “Risk factors of today are diseases of tomorrow”. A new campaign will be launched for breast cancer awareness titled “Know your breast”. Both campaigns are geared towards empowering the public to take responsibility for their health as a preventative measure. Other Initiatives include improving quality care at facility level and surveillance.
Sexual Reproductive Health
30. This financial year again my Ministry joined the international community in commemorating ‘Mo-vember’  to create awareness on neglected communicable and non- communicable diseases affecting men. The Mo-vember campaign seeks to promote Family Planning, prevention and management of STIs/HIV and AIDS, prevention of gender based violence and promotion of healthy lifestyle including advice against tobacco use, use of alcohol, promoting physical activity and healthy diets for men.
31. We continue to work tirelessly to address maternal and child mortality.  Strengthening capacity to improve quality of care for Mother and Newborns and children at health facilities is on-going. 
Laboratory Services
32. All Government hospital laboratories have been enrolled on the programme for Strengthening Laboratory Management towards Accreditation (SLMTA).  Sekgoma Memorial, Nyangabgwe and Princess Marina Hospital laboratories have been recommended for accreditation by Southern African Development Community Accreditation Service (SADCAS). Scottish Livingstone hospital laboratory is to be assessed in 2015 for possible accreditation. Like indicated in the previous speech, the accreditation status will not only give our local laboratories international recognition, but will also improve the quality of services provided.
Pharmaceutical Services
33. Chairperson, As of November 2014, the average availability of vital, essential and necessary medicines at Government health facilities stood at 90.9%, 89.2% and 84.9%, respectively. The outsourcing of warehousing and distribution of drugs to Botswana Couriers has improved efficiency and effectiveness of the medical commodities supply chain management and availability of medical supplies at Central Medical Stores has increased and at health facilities. Health facilities are now ordering and getting supplied regularly thus reducing inventory holding and reducing costs due to medicines expiring before they are dispensed for patient care services.
34. My Ministry has outsourced the dispensing of chronic care medicines to citizen owned private pharmacies to reduce patient waiting times and improve the quality of patient care services. This project, which started at Princess Marina Hospital in August 2013, is administered by Associated Fund Administrators and has enrolled 3,700 patients. Through this project, patient waiting times at Princess Marina Hospital pharmacy has been reduced to an average of 55 minutes which is below the set target of 60 minutes. Other districts will be considered in the future.
Emergency Medical Services
35. In a continued response to the burden of high incidence of deaths and disabilities from road crashes, emergency ambulance response centres or Emergency Medical Services have been rolled out to Palapye, Selebi Phikwe and Lobatse. This is in addition to the already established ones at Mahalapye, Francistown and Gaborone.  These services are critical to reduce lives on a daily basis on our roads and to minimise disability.
Patient Care
36. Chairperson, overcrowding in Princess Marina hospital is caused by lack of district hospital in greater Gaborone, self-referrals, inadequate supply chain management of drugs, equipment and consumables, increased population in greater Gaborone area and availability of skills set at the primary and district hospitals.
37. To address the supply of drugs, medical equipment and consumables problems, my Ministry has put in place framework contracts for the provision of these commodities. This approach has already led to a significant improvement in the availability of drugs throughout the country. To address the challenge of overcrowding, my Ministry has devolved some of the services to local clinics as well as to another hospital as follows;
37.1 Rheumatologist, dermatologist specialist services have been transferred to local clinics in Gaborone.
37.2 Services for ophthalmology, cardiac surgery and stable premature babies have been transferred to Scottish Hospital in Molepolole.
37.3 Low risk pregnancies are delivered at local clinics with maternity.
38. Other measures being taken include strengthening case management through carrying out daily ward rounds, strengthening outreach services to primary and district hospitals and engaging in patient education on self-referrals.
39. Chairperson, by May 2014 my Ministry had recorded 99% roll out of ARV services to health facilities. That is, all 565 clinics and health posts in all DHMTs with an exception of six are providing ARV services. To improve the quality of ARV services in these facilities, my Ministry will concentrate in reducing waiting times in different areas of ARV service provision like consultations and pharmacy.
40. My Ministry continues to hold Dipitso tsa Botsogo as an effort to improve the quality of health services and 91 of such were conducted in the first two quarters of this financial year compared to 38 in the last financial year. These allow information exchange between health care workers and the public. It is at these fora that the public gives feedback on the health services they receive. This feedback allows my Ministry to work on improving the health services.
Quality Improvement
41. Chairperson, a total of 16 health facilities has been enrolled in the accreditation programme with the Council of Health Services Accreditation for Southern Africa (COHSASA) and are at various levels of achievement.  Mahalapye and Scottish Livingstone hospitals have been able to maintain a pre-accreditation recognition Entry Level that was awarded to them in October 2013 while Airstrip, Xhosa, Phuthadikobo and Nkoyaphiri clinics have maintained a Progress Level. We are looking forward to an external survey for full accreditation to be conducted at these six facilities in 2015/2016. The remaining facilities namely Sekgoma Memorial, Letsholathebe II Memorial, Nyangabgwe, Princess Marina, S’brana Psychiatric, Athlone, Deborah Retief and Selibe Phikwe Hospitals, Julia Molefhe and Extension 2 clinics are being continuously assisted to move towards achievement of accreditation status. 

42. My Ministry has also launched, disseminated and commenced the implementation of five National Health Quality Standards for hospitals, clinics, mortuaries, environmental health and emergency medical services at both public and private health facilities to improve the quality and safety of health services.
Maintenance of Health Facilities
43. Chairperson, my Ministry will continue to utilise the services of an outsourced facilities management company to carry on the maintenance of health facilities across the country. Owing to limited resources, we experienced challenges in dealing effectively with maintenance in the 2014/15 financial year. Notwithstanding these challenges, I am pleased to inform the honourable house that a lot of progress was made in making our major hospitals of Princess Marina, Nyangabgwe, S’brana, Scottish, Mahalapye, Sekgoma and Letsholathebe II Memorial fit for purpose. These seven (7) major hospitals were upgraded and refurbished for services that include:  electrical, mechanical, fire detection, steam and chilled water, with most of the projects completed and contracts for their continued maintenance established.
44. Chairperson, as alluded to in my predecessor’s previous speech, a number of remaining district and primary hospitals had their installations refurbished during the 2014/15 financial year. These included Deborah Retief Memorial, Mmadinare, Gweta, Ghanzi, Goodhope and Gumare. Further refurbishments/upgrading will be undertaken in most of the hospitals and clinics in the 2015/2016 financial year.
45. A lot of day-to-day maintenance requests continue to be logged and dealt with through the established call centre. For instance, as of December 2014, Ten Thousand, Eight Hundred and Eighty One (10,881) calls were logged with the call centre on various maintenance related issues and Six Thousand, One Hundred and Thirty Three (6,133) of these have been attended to. This translates to 56.4% completion rate. Chairperson, we acknowledge that the completion rate has not been satisfactory and we intend to see an increase in the 2015/2016 financial year.
46. As we start the 2015/2016 financial year, a new contract will be in place which will see to an increase in the facilities management personnel deployed across the country. These personnel will be expected to effectively coordinate maintenance issues in their localities and as calls logged at the call centre increase, they will engage contractors in their localities as well as monitor, supervise and inspect work done by contractors.
47. Chairperson, let me assure Honourable members that my Ministry will always strive to optimise maintenance of health facilities across the country and we request their indulgence as we embark on this complex issue.
Outsourcing of non-core Services
48. Chairperson, we are entering the fifth year of the Ministry’s Outsourcing Strategy and Programme 2011-2016. It is worth sharing with this Honourable house that implementation of this strategy is satisfactory with a lot of activities done as planned. To this end, outsourcing of non-core activities like cleaning, grounds maintenance, laundry services and security has been done in the  three referral hospitals and four major district hospitals (Sekgoma Memorial, Scottish Livingstone, Letsholathebe II and Mahalapye).  Outsourcing of these will be extended to other district hospitals and selected primary hospitals in the 2015/2016 financial year as directed by the Programme and on need basis.  
49. Due to concerted effort to capacitate Ministry’s staff on various aspects of outsourcing like contract management, use of service level agreements, monitoring and evaluation, we have observed that there is better management of contracts and a lot of improvement in services delivery from the private sector.  My Ministry intends to strengthen its ability to manage these contracts during the 2015/2016 financial year and also engage the private sector to help them understand what is required of them in this partnership.
50. Allow me Chairperson, to let the Honourable members know that from my Ministry’s experience, outsourcing does not only lead to delivery of efficient and  quality services, entrepreneurship and investment as well as ensuring citizen participation, but also creation of employment.  In all non-core outsourcing contracts done so far, a total of One Thousand, One Hundred and Fourty (1,140) people have been employed across the country. This shows that people are gaining meaningful employment, and that outsourcing of our non-core services contributes to employment creation.

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Minister of Health Dorcas Makgato



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